LIFE CLAIMANT STATEMENT Lumico Life Insurance Company Mailing Address PO Box 83303 Lincoln, NE 685013303 INSTRUCTIONS The following items are required for all claims: O An original certified death.

How it works
  • Open form

    Open form follow the instructions

  • Easily sign form

    Easily sign the form with your finger

  • Share form

    Send filled & signed form or save

How to fill out the SR-GL Life Claimant Statement (CL G012F) ORIGINAL.doc online

Filling out the SR-GL Life Claimant Statement (CL G012F) is a crucial step in processing a life insurance claim. This guide provides clear instructions on how to complete the form online to ensure your submission is accurate and complete.

Follow the steps to successfully complete the SR-GL Life Claimant Statement online.

  1. Click 'Get Form' button to obtain the form and open it in your preferred editing application.
  2. Begin with the Decedent Information section. Enter the name of the deceased, the last four digits of their Social Security Number, and any other names they may have been known by. Include the policy number and the date of death.
  3. In the Claimant Information section, provide your name, physical address (no P.O. Boxes allowed), date of birth, Social Security or Tax ID number, and daytime phone number. Specify your relationship to the deceased and if you are a U.S. citizen.
  4. If there is a second claimant, complete the corresponding fields for their information. Repeat the details as in step 3.
  5. Select your preferred settlement option. Carefully review the options available and indicate your choice by name, ensuring to understand any required supporting documents.
  6. Complete the Signature section. Both claimants must sign the form, acknowledging that the information provided is complete and true, and agree to the stated terms.
  7. If claiming on behalf of a trust, complete the Trustee Certification section, including all necessary documentation such as a copy of the trust agreement.
  8. Once you have filled in all required fields and sections, save the changes made to the document. You may then download, print, or share the form as needed to submit your claim.

Take action now and complete your SR-GL Life Claimant Statement online for efficient processing of your claim.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

If you believe that this page should be taken down, please follow our DMCA take down process here.

Get SR-GL Life Claimant Statement (CL G012F) ORIGINAL.doc